高分化乳头状间皮瘤一例

患者女,41岁,因腹胀伴愎部隐痛5年余于2005年5月入院．体检：一般情况良好,追问病史患告以往曾有10年与职业相关的石棉接触史。入院后行腹腔镜检查时发现在子宫、双附件、回肠、阑尾、直肠等器官和肠系膜及盆腔底部腹膜表面有多发性散在分布的灰白色半透明结节,0．2～1．5cm大小。另见盆腔内有少量积液．于术中分别取盆底、右输卵管及肠系膜病变组织,同时抽取腹水20ml送检。     

腹膜高分化乳头状间皮瘤1例

腹膜高分化乳头状间皮瘤（well-differentiated papillary mesothelial tumor,WDPMT）是一种罕见的间皮来源良性肿瘤,好发于育龄女性。本文报道1例术中偶然发现的腹膜WDPMT,肿瘤镜下形成乳头状、管状结构,被覆单层立方上皮,形态温和,未见核分裂象,未见间质浸润。免疫组织化学肿...     

腹膜分化型乳头状间皮瘤一例

患者男 ,5 7岁。因腹胀半年余于 2 0 0 2年 3月 2 0日入院。患者两年半前因右腹股沟斜疝在外院手术 ,术中见疝囊壁上有多灶性白色疣状物 ,腹腔内腹膜表面也有同样表现 ,颗粒大小 0 2～ 0 5cm。病理诊断 :腹膜间皮增生。患者术后未进行任何治疗。因近半年感觉腹胀 ,逐渐明显 ,来我院诊治。腹腔镜检查见腹腔内有腹水 2 0 0ml,淡黄色 ,腹膜及大网膜上均有弥漫性粟粒样结节 ,直径 0 2～ 0 3cm。取活检。病理检查 :镜下观察病变组织呈多灶性乳头状生长 ,乳头宽窄不一 ,多数为Ⅰ～Ⅱ级乳头 ,乳头中心由疏松结缔组织和薄壁血管构成 ,部分间质纤…     

盆腔腹膜高分化乳头状间皮瘤1例

正患者女性,29岁,因左侧卵巢未成熟性畸胎瘤术后化疗1个疗程后于2016年1月19日入院。患者平素月经规则,2015年11月在外院行腹腔镜下左侧卵巢畸胎瘤剔除术,术后病理报告提示:左侧卵巢未成熟性畸胎瘤Ⅱ级,于2015年12月给予BEP方案化疗。体检:患者一般情况良好,心肺未及异常,腹部平坦,压痛反跳痛阴性,肝脾肋下未触及,移动性浊音阴性,胸片、心电图未见明显异常。术前诊断:(1)左     

盆腹膜弥漫性高分化乳头状间皮瘤1例

患者女性,54岁.因下腹隐痛6个月,发现盆腔包块1个月余入院.B超示:左侧附件区占位4.1 cm×3.0 cm×4.3 cm,右侧附件区查见弱回声团5.8 cm×3.6 cm×5.1 cm,右侧中腹囊实性占位6.7 cm×4.1 cm×6.1 cm,盆腔积液深1.7 cm.术中见:双附件区均可见直径约5 cm肿物,双卵巢与双输卵管形态可见,子宫正常大小,其后壁浆膜面及盆腹膜、直肠、乙状结肠表面均可见弥散分布的灰白色乳头状肿物.     

大网膜退分化性脂肪肉瘤

临床资料患者,女,17岁。发作性腹痛5个月,呈刺痛、钝痛,偶呈绞痛,发作及持续时间均不定,一月前偶发现下腹部包块,生长迅速,伴明显食欲下降,体重减轻,于1988年8月17日就诊。     

大网膜蛔虫性肉芽肿一例

患者女 ,38岁 ,农民。因腹胀、腹围进行性增大 1个月 ,于 1999年 6月 17日入院。患者于 4月底突觉腹部剧烈疼痛 ,持续 3～ 4ｄ。 5月中旬起感觉腹胀不适。ＣＴ检查 ,发现右下腹大网膜增厚呈“饼状” ,密度不均匀 ,伴大量腹腔积液 ,拟诊为结核性腹膜炎。体检 :腹软无压痛 ,肝脾肋下未及 ,腹水征阳性。妇科检查 :子宫右上方扪及 3ｃｍ× 3ｃｍ包块。实验室检查 :白细胞 11 2× 10 9 Ｌ ,血沉 2 5ｍｍ ｈ ,肝肾功能及粪尿常规均正常 ,腹水为渗出液 ,其中未找到肿瘤细胞。行剖腹探查 ,术中见腹腔内黄绿色液体约 6 0 0ｍｌ,大网膜上广泛散在分布…     

小儿大网膜囊肿一例报告

患儿,男,6岁,无意中发现腹中部有一肿块一月而入院。入院后查体:T:36.4℃,P:82次/分,R:20次/分,Bp:15/9 kPa,发育中,营养良,全身皮肤无黄染,淋巴结未及肿大。双肺呼吸音清,心音有力,腹中部有一肿块,触之有囊性感活动极佳,甚可推到肝下,无触痛。肠音正常。实验室检查:白细胞7.1×10~9/L,彩超示腹腔内囊性肿块,10cm×7cm×5cm。术中所见:于住院后     

大网膜囊肿疝入阴囊一例

一、临床资料:男性,2岁。右侧阴囊巨大可复性肿块一年。查体:腹部明显膨隆,右侧阴囊内可见一直径约15cm卵圆形包块,透光试验( ),包块挤压或平卧后可消失。诊断为右侧腹股沟斜疝。手术所见:取右侧腹股沟疝切口,打开疝囊可见大量多房性半透明的囊性肿物通过内环口不断涌出,越牵越多,找不到尽头。从内环口向上纵形延长切口进入腹腔,可见囊性肿物源于大网膜,且布满大网腹。于胃大弯和横结肠缘将肿物完整切除后行疝囊高位结扎。切除肿物约4kg术后腹部明显塌陷。病例报告:大网膜囊肿。     

心脏恶性间皮瘤一例

临床资料男性 ,6 3岁 .进行性消瘦 3月 ,两次彩超检查均报告右房前外侧游离壁 4 2～ 6 0× 31～ 34ｍｍ不均质团块回声 ,向三尖瓣瓣环附近延伸 ,考虑右房肿瘤 .ＭＲＩ显示右室流出道之前外侧壁及下壁明显增厚成肿块状 ,其前后径约 80ｍｍ ,左右径约 70ｍｍ ,病变主要沿流出道向心尖部伸展 ,提示心肌肿瘤可能 .术前诊断倾向于恶性肿瘤 .手术在全麻下进行 ,胸骨正中切口 ,切开心包发现约 12 0ｍｌ血性积液 ,心外探查见右室前壁及膈面隆起一肿块 ,约 90× 75ｍｍ ,向心尖延伸 ,其边界不清 ,质硬 .右房室沟与升主动脉旁各有一块大淋巴结 ,约 10…     

Well-differentiated papillary mesothelioma manifesting in a hernia sac

Well-differentiated papillary mesothelioma (WDPM) is a tumor of uncertain malignant potential that usually occurs as a multifocal lesion of the female peritoneum, and is incidentally found at the time of surgery. We present here a multifocal case that had arisen from the lining of a hernia sac. To our knowledge, only four cases of this event have been previously described. A review of the five cases reported, including our case, revealed that the mean age of the patients was 56.6 ± 8.35 years. There was predominance in men (4:1). In four cases, the lesion was incidental. Most tumors were found in inguinal hernias. Four cases presented with gross abnormalities in the hernia sac. All the five patients were alive with no evidence of WDPM after a mean follow-up of 38.6 months. Extensive sampling of this rare lesion helps to rule out an epithelial malignant mesothelioma and prevents overtreatment.     

Well-differentiated papillary mesothelioma of the tunica vaginalis: A case report with aspirate cytologic,immunohistochemical, and ultrastructural studies

A case of a well-differentiated papillary mesothelioma of the tunica vaginalis testis in a 70-year-old man, who presented with a 1-month history of scrotal swelling with hydrocele, is described. Fine needle aspiration cytology of the hydrocele demonstrated a papillary cluster of uniform round cells with minimal atypia, reminiscent of mesothelial cells. Macroscopically, the lesion was characterized by a solitary, well-circumscribed papillary soft tumor measuring 1.2×1.2×1.0 cm³. Histologically, the tumor exhibited papillary or tubulopapillary proliferation of predominantly bland cuboidal cells. No cellular pleomorphism, mitotic figures, necrosis, or stromal invasion was noted. Immunohistochemically, the tumor was positive for CAM5.2, epithelial membrane antigen, vimentin, calretinin, and D2-40, but negative for carcinoembryonic antigen. Ki-67 index was less than 1%. Ultrastructurally, the tumor cells showed numerous microvilli, mitochondria, rough endoplasmic reticulum, microfilaments, and desmosomes. The patient is alive with no evidence of disease at 18 months after right radical orchiectomy. Ki67 may be potentially a good maker for differentiating low-grade from high-grade mesothelioma.     

Cytomorphologic features of well-differentiated papillary mesothelioma in peritoneal effusion: a case report

Well-differentiated papillary mesothelioma (WDPM), a distinct subtype of diffuse malignant mesothelioma, usually occurs in the peritoneum and is seen most commonly in women of reproductive age. Histologic features of WDPM include papillary growth and stout fibrous cores surrounded by a single layer of tumor cells. We present the case of a 73-year-old woman without subjective symptoms who showed signs of peritoneal effusion during a routine examination and for whom cytologic examination of the ascitic fluid was performed. Many spherical clusters, with a smooth external surface composed of a single layer of uniform cuboidal cells, were observed. Within each cluster, a collagenous ball showed light green Papanicolaou staining. Immunohistochemistry of surgical specimens showed tumor cells positive for calretinin, D(2)-40, and HBME-1 staining. The histologic diagnosis was WDPM. The identification of a collagenous ball within these clusters is a useful cytologic finding for the diagnosis of WDPM. WDPM should be suspected when numerous collagenous balls are present by effusion cytology and isolated cells are not.     

Well-differentiated papillary mesothelioma: A 17-year single institution experience with a series of 75 cases

We present our experience with 75 cases of well-differentiated papillary mesothelioma (WDPM) that were diagnosed at our institution between 2000 and 2017. The patients included 58 females and 17 males with age ranging from 18 to 69 years (mean, 42 years). Clinically, the vast majority of WDPMs were incidental findings during laparotomy or laparoscopic surgery for a variety of benign or malignant disease. The lesion manifested as either a small solitary nodule or multiple miliary nodules on the peritoneum or serosal surfaces of internal organs. Histologically, 67 cases were consistent with a classical WDPM, of which 6 cases contained microinvasive foci and 1 case had malignant transformation. Eight cases were hybrid tumors with variable combined component of adenomatoid tumor (n = 4), multicystic mesothelioma (n = 2), and both (n = 2). By immunohistochemistry, besides calretinin, D2-40, CK5/6 and WT1, 94% (29/31) of cases also showed immunostaining for PAX8. In comparison, PAX8 staining was only present in 12% (6/50) of epithelioid malignant mesothelioma selected as control cases. Follow-up information available in 46 cases revealed no signs of tumor progression or local recurrence except for the case that showed transformation to a fully malignant mesothelioma after a period of 15 years. Our comprehensive study further expanded the clinical and histopathological spectrum of WDPM. Compared with epithelioid malignant mesothelioma, PAX8 staining is highly sensitive and specific for WDPM (P < 0.001).     

Paratesticular papillary mesothelioma: a case with borderline features

Most often, mesotheliomas involve the serosal (serous) membranes of the pleura and peritoneum. Sometimes, mesothelial proliferations are identified in other locations. On very rare occasions, a mesothelioma is found within the tunica vaginalis of the paratesticular region. We report a case of papillary mesothelioma of the tunica vaginalis in a 52-year-old man. Although this lesion had papillary structures lined by a single layer of mesothelial cells with predominantly bland nuclear and cytologic features, there was evidence of a minimal presence of mesothelial cells in the underlying stroma. This combination of benign and semimalignant characteristics can make the diagnosis of such a lesion problematic. We think that a diagnosis of "borderline papillary mesothelioma" can be considered for similar mesothelial proliferations to allow for a possible increase in diagnostic accuracy and provide an enhanced informational platform from which patients and clinicians can benefit.     

Combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum

Herein is reported a highly rare case of combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum. A 45-year-old Japanese man was incidentally found to have a mesenteric mass during abdominal ultrasonography. Grossly, a well-circumscribed and non-encapsulated tumor, measuring 24 × 23 × 22 mm, was located in the omentum with no obvious invasion to the surrounding stomach and pancreas. Microscopically, the tumor consisted of two histological distinct components; the majority of it showed irregular arrangement of numerous cysts lined by a single layer of flattened or epithelioid cells and the multifocal minor component exhibited prominent papillary protrusions lined by a single layer of cuboidal cells with relatively uniform nucleus. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin (AE1/AE3), vimentin, calretinin, D2-40 and WT-1, and negative for epithelial membrane antigen (EMA), desmin, S-100 protein and CD68. Ki-67 labeling index of the tumor cells was <5%. The postoperative course was uneventful, though he has not received any adjuvant therapy. Despite the rarity, recognition of such combined cases of mesothelial lesions is important to prevent overdiagnosis.     

Multicystic peritoneal mesothelioma: a case report

A case of recurrent cystic peritoneal mesothelioma is reported. Ultrastructurally the tumour cells showed abundant surface microvilli, desmosomes, intracytoplasmic filaments and well-developed basal lamina. The cells demonstrated positive staining for keratin peptides, vimentin and epithelial membrane antigen and, some of them, for carcinoembryonic antigen. No staining was demonstrable for a number of endothelial markers. The findings are in accord with the proposed mesothelial origin of the neoplasm and can be of help in the differential diagnosis of other multicystic neoplasms arising in the peritoneal cavity.     

Well‐differentiated papillary mesothelioma,possibly giving rise to diffuse malignant mesothelioma: A case report

Well‐differentiated papillary mesothelioma (WDPM) is a distinct subtype of mesothelial tumor from diffuse malignant mesothelioma (DMM), with an uncertain malignant potential. The relationship between WDPM and DMM, with regard to the ability of the former to develop into the latter, is also unknown. A 58‐year‐old woman, diagnosed with a rectal carcinoid tumor, underwent removal of the lymph nodes via the abdomen in 2004. A large number of white miliary nodules were identified on the mesentery and peritoneum, which were histologically diagnosed as WDPM. No further therapy was administered, but the patient was followed‐up using imaging methods. Seven years later, an abdominal wall mass was discovered using positron emission tomography‐computed tomography, and a laparotomy biopsy was performed. DMM was diagnosed, because mesothelioma with extended invasion had been histologically identified. Mesothelioma similar to papillary proliferation was present on the outer layer of the peritoneum, and an infiltrating lesion with continuous restiform or solid‐like structures was noted. WDPM was believed to have undergone malignant transformation. Compared to DMM, WDPM has a good prognosis and is considered a benign or borderline neoplasm. Our findings suggest that WDPM does have malignant potential, however, because histological findings indicated a malignant transformation of WDPM to DMM.